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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO, 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE: 588~147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />$1GNATURI[ OF APRI,.ICANT; ........................................
<br />
<br /> DATE: 02/2,47,-9-A- ..... T~-I,L~ :.., L4: 23 :,~.6 ........... ,.,,,~,-~-~.-~ ............................... ~ ~9~o~ ........... ,
<br /> ' ~ R~g!DYNT/AL,
<br /> OV~RFIE~D, MARK 71010850 ................... . .................
<br />S~bhi~: ....................................................... ~ ~b~ ~ ~ ........... ~cu.~:
<br />
<br /> 13640 ~!ST~RIA DR ~ ~h~f~,~V: ..... ]-~: .............. ~-~FA~'~6~6 ..........
<br />
<br /> - ............................................................................. ~5. ~'~6b.~: "'~
<br />7~ ' ~ '~O]g~qA~ .................. ~ '
<br /> ~ 3_ "
<br />
<br /> PO BoX 239 ;
<br /> 97033 ~ SI~ ~: 94-00801
<br /> HUBBARD
<br /> P~ONZ: 9g%-7187 ~ VALUATION:
<br />
<br /> /
<br />..... ~ · ~ ,~. ~ A~ ........ ~., ,~ ..............
<br /> ~E~H; i AREA: ~ UNITS: ~ IAR~. ~ COAN~".
<br />
<br />TYPE: ON-SITE SWAGE
<br />
<br />PERH!T OR APPLICATION NO:
<br />
<br />9053139
<br />
<br />I ~AT~.R SUPPLY:
<br />
<br />276
<br />
<br />CONTRACTOR, NO.
<br />OVERFIELD, MARK
<br />PO BOX 239 ''
<br />HUBBARD OREGON 9703~
<br />PHONE: 981-7187
<br />
<br />~ TEST HOLES READY:
<br />I SITE EVALUATION NUMBER:
<br />' EXISTING TANK SIZE: I000
<br />I EXISTING DRAIN FIELD LINES:
<br />! S~PTIC.,TANK PUNPED: 2/8/94
<br />''PREVIOUS NO~.,BEDROONS: 3
<br />
<br /> ITEM , .: '. QU~TITY AMOUNT
<br />AUTHORIZATION NOTICE - FLD. VISI~ , .,.:. 1 $160.00
<br />
<br /> ,, .. , T0?A~ A'ssEs. sED..'FEE~ $160,00
<br /> · . . .'.~7,,*~REViOU~ RECEIPTS $0.00
<br /> $160.00
<br /> ...... .".'. · '.'. :..,,. :: ',, j,,~!s,-~E~P? ..
<br /> · ".' ' ........... -:'"'"' :: ,": · o_ oo
<br />PAYEE: OVERFIELD, KARK; ......... :.';~:',':!~;':'::::' ..... :. ~ECEIPT NO: 555~6 ~
<br />
<br />SEE ATTACHED DOCUMENT ::FOR REQUI~EN~$~OF'ON~sITE SEWAGE SYSTEM°
<br />· THIS.IS NOT A PEP. NIT.,' ,~3:~'$, ~P~LICATiON':~Us~:]GO %'NRO~GR A REVIEW pROCESS ~NERE THE
<br />FOLLO~mNG MUST BE COMPLETED'.', i.T 'i~ THE'-RESPONSIBILITY O~ T~E APPDTCANT TO ASSURM ~t~A~
<br />ALL NECESSARy INFORMATION' HAS'BEEN.PROViDED.'
<br />
<br />PLAN REVIEW: HY
<br />RE~ARK$:
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